54 Zhang et al
World J Emerg Med, Vol 4, No 1, 2013
Original Article
Correlations between quality indexes of chest compression Feng-ling Zhang, Li Yan, Su-fang Huang, Xiang-jun Bai Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China Corresponding Author: Su-fang Huang, Email: [email protected]
BACKGROUND: Cardiopulmonary resuscitation (CPR) is a kind of emergency treatment for cardiopulmonary arrest, and chest compression is the most important and necessary part of CPR. The American Heart Association published the new Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care in 2010 and demanded for better performance of chest compression practice, especially in compression depth and rate. The current study was to explore the relationship of quality indexes of chest compression and to identify the key points in chest compression training and practice. METHODS: Totally 219 healthcare workers accepted chest compression training by using Laerdal ACLS advanced life support resuscitation model. The quality indexes of chest compression, including compression hands placement, compression rate, compression depth, and chest wall recoil as well as self-reported fatigue time were monitored by the Laerdal Computer Skills and Reporting System. RESULTS: The quality of chest compression was related to the gender of the compressor. The indexes in males, including self-reported fatigue time, the accuracy of compression depth and the compression rate, the accuracy of compression rate, were higher than those in females. However, the accuracy of chest recoil was higher in females than in males. The quality indexes of chest compression were correlated with each other. The self-reported fatigue time was related to all the indexes except the compression rate. CONCLUSION: It is necessary to offer CPR training courses regularly. In clinical practice, it might be better to change the practitioner before fatigue, especially for females or weak practitioners. In training projects, more attention should be paid to the control of compression rate, in order to delay the fatigue, guarantee enough compression depth and improve the quality of chest compression. KEY WORDS: Cardiopulmonary resuscitation; Chest compression; Quality indexes; Correlation World J Emerg Med 2013;4(1):54–58 DOI: 10.5847/ wjem.j.issn.1920–8642.2013.01.010
INTRODUCTION Cardiopulmonary resuscitation (CPR) is a kind of emergency treatment for cardiopulmonary arrest, and chest compression as the most important and necessary part of CPR requires the practitioners to compress the www.wjem.org © 2013 World Journal of Emergency Medicine
center of the victim's chest deeply and quickly as soon as possible after cardiopulmonary arrest occurs. The kind of practice can maintain the function of cardiac pump by forcing the heart to pump blood, and creating certain negative pressure of the chest to force blood backflow
World J Emerg Med, Vol 4, No 1, 2013
at the meantime. [1,2] High-quality chest compression can maintain effective blood circulation and guarantee blood supply for critical organs in a short term after cardiopulmonary arrest occurs, which acts as the most basic treatment before advanced treatment is available. It increases the survival rate and decreases the irreversible damage to the nervous system caused by hypoxiaischemia and ultimately improves the prognosis of patients.[2,3] "2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" (2010 AHA guidelines) as one of the most authoritative guidelines was published in 2010 and demanded for better performance of chest compression practice. It called for a rate of "at least 100 beats/min" and a depth of "at least 5cm" while offering chest compression in CPR, [4] which directly raised the difficulty of practicing chest compreesion for practitioners. So far, the research based on clinical CPR practice was rare,[5] while most of the published articles reported the practice of CPR still owe specification among healthcare workers.[6] In the current research project, the research team offered training to healthcare workers by using Laerdal ACLS advanced life support resuscitation model, and monitored the quality issues of chest compression, including compression hands placement, compression rate, compression depth, and chest wall recoil, as well as self-reported fatigue time by Laerdal Computer Skills and Reporting System. After the training, data were analyzed to explore the inner correlation of the quality indexes in order to guide later CPR training and clinical practice.
METHODS Study population and design Totally 219 subjects were selected randomly from an AAA hospital by convenient sampling. All the recruits only practiced chest compression based on "2010 AHA guidelines" for 2 minutes in this study by the Laerdal ACLS advanced life support resuscitation model. The quality indexes of chest compression, including compression hands placement, compression rate, compression depth, and chest wall recoil, were monitored by the Laerdal Computer Skills and Reporting System. Meanwhile, self-reported fatigue time was recorded. The recruits were required to keep the knee position to the chest level of the model during the practice of chest compression, to ensure the shoulders to be just above the center of the model's chest in order to compress vertically.
55
Data collection The basic information including age, gender, title, and education level, etc was recorded before the training. Data about the quality indexes of chest compression were recorded by the Laerdal Computer Skills and Reporting System and logged into a computer. Accuracy of four quality indexes including compression hands placement, compression rate, compression depth, and chest wall recoil was presented in the form of percentage. Compression rate was also presented in the form of average rate, and selfreported fatigue time was presented in degree of second. Among the six variables, accuracy of hands placement was calculated with the number of compressions with correct hands placement divided by the total number of compressions (%); the average rate of chest compression was the mean compression rate recorded by the recording system (beats/min); accuracy of compression rate was calculated with the number of compressions with a rate over 100 beats/min divided by the total number of compressions (%); accuracy of deep-compression was calculated with the number of compressions with depth more than 5 cm divided by the total number of compressions (%); accuracy of chest recoil was calculated with the number of compressions with complete chest recoil divided by the total number of compressions (%); self-reported fatigue time was the time when the practitioner experienced decrease of compression depth because of fatigue which directly reported by the practitioners after finishing the compression (s). Statistical analysis Data were analyzed using SPSS version 12.0 (SPSS Inc, Chicago, IL, USA). Basic information about the subjects was descriptively expressed. One-way ANOVA and Student's t test was used to assess the differences between different genders, ages, titles, and education levels of the recruits. Correlation analysis was used to explore the relationship among the quality indexes of chest compression. A P value
World J Emerg Med, Vol 4, No 1, 2013
Original Article
Correlations between quality indexes of chest compression Feng-ling Zhang, Li Yan, Su-fang Huang, Xiang-jun Bai Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China Corresponding Author: Su-fang Huang, Email: [email protected]
BACKGROUND: Cardiopulmonary resuscitation (CPR) is a kind of emergency treatment for cardiopulmonary arrest, and chest compression is the most important and necessary part of CPR. The American Heart Association published the new Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care in 2010 and demanded for better performance of chest compression practice, especially in compression depth and rate. The current study was to explore the relationship of quality indexes of chest compression and to identify the key points in chest compression training and practice. METHODS: Totally 219 healthcare workers accepted chest compression training by using Laerdal ACLS advanced life support resuscitation model. The quality indexes of chest compression, including compression hands placement, compression rate, compression depth, and chest wall recoil as well as self-reported fatigue time were monitored by the Laerdal Computer Skills and Reporting System. RESULTS: The quality of chest compression was related to the gender of the compressor. The indexes in males, including self-reported fatigue time, the accuracy of compression depth and the compression rate, the accuracy of compression rate, were higher than those in females. However, the accuracy of chest recoil was higher in females than in males. The quality indexes of chest compression were correlated with each other. The self-reported fatigue time was related to all the indexes except the compression rate. CONCLUSION: It is necessary to offer CPR training courses regularly. In clinical practice, it might be better to change the practitioner before fatigue, especially for females or weak practitioners. In training projects, more attention should be paid to the control of compression rate, in order to delay the fatigue, guarantee enough compression depth and improve the quality of chest compression. KEY WORDS: Cardiopulmonary resuscitation; Chest compression; Quality indexes; Correlation World J Emerg Med 2013;4(1):54–58 DOI: 10.5847/ wjem.j.issn.1920–8642.2013.01.010
INTRODUCTION Cardiopulmonary resuscitation (CPR) is a kind of emergency treatment for cardiopulmonary arrest, and chest compression as the most important and necessary part of CPR requires the practitioners to compress the www.wjem.org © 2013 World Journal of Emergency Medicine
center of the victim's chest deeply and quickly as soon as possible after cardiopulmonary arrest occurs. The kind of practice can maintain the function of cardiac pump by forcing the heart to pump blood, and creating certain negative pressure of the chest to force blood backflow
World J Emerg Med, Vol 4, No 1, 2013
at the meantime. [1,2] High-quality chest compression can maintain effective blood circulation and guarantee blood supply for critical organs in a short term after cardiopulmonary arrest occurs, which acts as the most basic treatment before advanced treatment is available. It increases the survival rate and decreases the irreversible damage to the nervous system caused by hypoxiaischemia and ultimately improves the prognosis of patients.[2,3] "2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" (2010 AHA guidelines) as one of the most authoritative guidelines was published in 2010 and demanded for better performance of chest compression practice. It called for a rate of "at least 100 beats/min" and a depth of "at least 5cm" while offering chest compression in CPR, [4] which directly raised the difficulty of practicing chest compreesion for practitioners. So far, the research based on clinical CPR practice was rare,[5] while most of the published articles reported the practice of CPR still owe specification among healthcare workers.[6] In the current research project, the research team offered training to healthcare workers by using Laerdal ACLS advanced life support resuscitation model, and monitored the quality issues of chest compression, including compression hands placement, compression rate, compression depth, and chest wall recoil, as well as self-reported fatigue time by Laerdal Computer Skills and Reporting System. After the training, data were analyzed to explore the inner correlation of the quality indexes in order to guide later CPR training and clinical practice.
METHODS Study population and design Totally 219 subjects were selected randomly from an AAA hospital by convenient sampling. All the recruits only practiced chest compression based on "2010 AHA guidelines" for 2 minutes in this study by the Laerdal ACLS advanced life support resuscitation model. The quality indexes of chest compression, including compression hands placement, compression rate, compression depth, and chest wall recoil, were monitored by the Laerdal Computer Skills and Reporting System. Meanwhile, self-reported fatigue time was recorded. The recruits were required to keep the knee position to the chest level of the model during the practice of chest compression, to ensure the shoulders to be just above the center of the model's chest in order to compress vertically.
55
Data collection The basic information including age, gender, title, and education level, etc was recorded before the training. Data about the quality indexes of chest compression were recorded by the Laerdal Computer Skills and Reporting System and logged into a computer. Accuracy of four quality indexes including compression hands placement, compression rate, compression depth, and chest wall recoil was presented in the form of percentage. Compression rate was also presented in the form of average rate, and selfreported fatigue time was presented in degree of second. Among the six variables, accuracy of hands placement was calculated with the number of compressions with correct hands placement divided by the total number of compressions (%); the average rate of chest compression was the mean compression rate recorded by the recording system (beats/min); accuracy of compression rate was calculated with the number of compressions with a rate over 100 beats/min divided by the total number of compressions (%); accuracy of deep-compression was calculated with the number of compressions with depth more than 5 cm divided by the total number of compressions (%); accuracy of chest recoil was calculated with the number of compressions with complete chest recoil divided by the total number of compressions (%); self-reported fatigue time was the time when the practitioner experienced decrease of compression depth because of fatigue which directly reported by the practitioners after finishing the compression (s). Statistical analysis Data were analyzed using SPSS version 12.0 (SPSS Inc, Chicago, IL, USA). Basic information about the subjects was descriptively expressed. One-way ANOVA and Student's t test was used to assess the differences between different genders, ages, titles, and education levels of the recruits. Correlation analysis was used to explore the relationship among the quality indexes of chest compression. A P value
